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目的探讨前置胎盘数字化三维模型上构建的子宫切口模拟线在前置胎盘剖宫产术中的应用价值。方法选取2014年1月至2016年1月因前置胎盘在南方医科大学南方医院行剖宫产的单胎孕妇45例作为研究组,利用其术前磁共振(MRI)数据进行在体胎盘-子宫-骨盆数字化三维模型重建,在三维模型上多点测量前壁胎盘边缘与耻骨联合上缘水平线的垂直距离,确定胎盘边缘线,并根据胎盘在子宫前壁的位置对前置胎盘进行分型。根据胎盘分型和胎盘边缘线,在无胎盘区构建子宫切口模拟线。以前置胎盘边缘线和子宫切口模拟线为指导选择前置胎盘剖宫产术中子宫切口。同期用其他方法确定子宫切口的前置胎盘患者89例作为对照组,观测两组手术总失血量、输血率、手术时间、子宫切除率、术后住院天数、新生儿Apgar评分等围术期相关指标。结果研究组术前确定的胎盘位置与术中确定的胎盘位置符合率100%。对预计可避开胎盘患者,按照子宫切口模拟线切开子宫,胎盘避开率100%。研究组和对照组孕妇失血量(mL)(678.65±649.54 vs.933.96±695.25)、手术时间(min)(65.13±27.38 vs.86.88±54.43)、输血率(24.45%vs.42.69%)比较差异均有统计学意义(P<0.05),对照组的失血量、输血率明显高于研究组,手术时间明显长于研究组。两组孕妇产后24 h出血量≥1000 mL发生率、子宫切除率、病死率、新生儿Apgar评分(1、5 min)<7分的发生率等比较差异均无统计学意义(P>0.05)。结论胎盘数字化三维模型上构建的胎盘边缘线和子宫切口模拟线在指导前置胎盘手术时,能有效避开胎盘,减少术中出血,缩短手术时间,为临床中前置胎盘剖宫产术有效避开胎盘提供了一个新方法,具有一定的应用前景。
Objective To investigate the value of uterine incision simulation line constructed on digitized three-dimensional model of placenta previa in cesarean section of placenta previa. Methods From January 2014 to January 2016, 45 pregnant women with singleton cesarean section in Nanfang Hospital of Southern Medical University from January 2014 to January 2016 were selected as the study group. Preoperative magnetic resonance (MRI) Uterus - pelvis digital three-dimensional model reconstruction, multi-point measurement in the three-dimensional model of the anterior wall of the placenta and pubic symphysis upper edge of the horizontal distance of the vertical line to determine the placental margin line, and according to the position of the placenta in the anterior wall of the uterus placenta previa classification . According to placental classification and placental margins, uterine incision simulation line in the non-placental area. The placenta previa line and the uterine incision simulation line guide the choice of placenta previa cesarean section incision. In the same period, 89 cases of placenta accreta placenta previa were selected as the control group. Perioperative correlations of total blood loss, blood transfusion rate, operation time, hysterectomy, postoperative hospital stay, neonatal Apgar score were observed index. Results The preoperative placenta location and the intraoperative placenta location coincidence rate of 100%. Placenta is expected to be avoided in patients with uterine incision in accordance with the simulated line cut uterus, placenta avoidance rate of 100%. The blood loss of pregnant women in study group and control group (mL) (678.65 ± 649.54 vs.933.96 ± 695.25), operation time (min) (65.13 ± 27.38 vs.86.88 ± 54.43) and blood transfusion rate (24.45% vs.42.69% (P <0.05). The blood loss and transfusion rate of the control group were significantly higher than those of the study group, and the operation time was significantly longer than that of the study group. The incidence of hemorrhage≥1000 mL, hysterectomy, case fatality rate, neonatal Apgar score (<1, 5 min) <7 were not significantly different between the two groups (P> 0.05) . Conclusions The placenta marginal line and the uterine incision simulation line constructed on the digitized 3D model of placenta can effectively avoid the placenta, reduce the intraoperative bleeding and shorten the operation time when guiding the placenta previa, which is effective in clinical application of cesarean section in the placenta previa Avoid the placenta provides a new method, has a certain application prospects.